Strangulated Hernia Symptoms: Warning Signs and When to Seek Emergency Care

A strangulated hernia occurs when tissue trapped within a hernia loses its blood supply. This is a serious medical emergency that requires immediate evaluation and treatment.

Warning signs may include sudden or rapidly worsening pain, a very tender or swollen hernia, nausea or vomiting, and changes in the color of the skin over the hernia. If you have a known or suspected hernia and develop severe or rapidly worsening symptoms, seek emergency medical care.

What Is a Strangulated Hernia?

A hernia develops when tissue pushes through a weak area or opening in the surrounding muscle or connective tissue.

Sometimes, the tissue within a hernia becomes trapped and can no longer move back into its normal position. This is called an incarcerated hernia.

If pressure on the trapped tissue reduces or cuts off its blood supply, the hernia becomes strangulated. Without adequate blood flow and oxygen, the affected tissue can become damaged. This is why a strangulated hernia requires emergency medical treatment.

What Are the Symptoms of a Strangulated Hernia?

The symptoms of a strangulated hernia can develop or worsen quickly.

Possible warning signs include:

• Sudden or severe pain at the hernia site
• Pain that becomes rapidly worse
• A hernia that is increasingly tender or swollen
• A bulge that becomes firm or cannot move back into place
• Nausea or vomiting
• Abdominal pain or swelling
• Redness, paleness, darkening, or another noticeable color change in the skin over the hernia
• Symptoms of bowel obstruction when intestine is trapped

Cleveland Clinic specifically identifies increasing pain, nausea, vomiting and color changes around the hernia among possible signs of strangulation.

Do not wait for every symptom on this list to appear. A painful hernia that suddenly changes or is accompanied by significant nausea, vomiting, or worsening abdominal symptoms warrants prompt medical evaluation.

Incarcerated vs. Strangulated Hernia: What Is the Difference?

An incarcerated hernia and a strangulated hernia are related, but they are not the same condition.

An incarcerated hernia means the contents are stuck. Strangulation means the trapped tissue has also developed compromised blood flow.

Learn more about incarcerated hernias.

Can an Incarcerated Hernia Become Strangulated?

Yes. An incarcerated hernia can progress to strangulation if pressure on the trapped tissue interferes with its blood supply.

However, patients should not try to determine on their own whether a painful hernia is merely incarcerated or has become strangulated. Significant or rapidly worsening pain, vomiting, a newly firm hernia, or changes in the appearance of the bulge require medical evaluation.

Why Is a Strangulated Hernia an Emergency?

Blood carries oxygen to tissues throughout the body. When a hernia becomes strangulated, the trapped tissue does not receive adequate blood flow and oxygen.

Without timely treatment, the affected tissue can become seriously damaged and may lead to additional complications. Untreated strangulation can result in tissue death, serious infection, and potential loss of life.

For this reason, a suspected strangulated hernia should be treated as an emergency rather than monitored at home.

Which Types of Hernias Can Become Strangulated?

Strangulation can occur when tissue becomes trapped within certain abdominal or groin hernias.

Examples include:

• Inguinal hernias
• Femoral hernias
• Umbilical hernias
• Incisional hernias
• Epigastric hernias
• Spigelian hernias

The risk is not the same for every hernia type. Femoral hernias, for example, are treated particularly carefully because of their tendency to become trapped and strangulated.

Can a Strangulated Hernia Cause a Bowel Obstruction?

Yes, in some cases.

If part of the intestine becomes trapped within a hernia, it can interfere with the normal movement of intestinal contents and cause a bowel obstruction.

Symptoms of intestinal obstruction can include:

• Severe abdominal pain or cramping
• Vomiting
• Abdominal bloating or swelling
• Constipation
• Inability to pass gas

Hernias are one recognized cause of intestinal obstruction.

However, the absence of constipation or an inability to pass gas does not rule out strangulation. The symptoms depend on which tissue is trapped and the type of hernia.

Can You Push a Strangulated Hernia Back In?

A painful or suddenly changed hernia should be medically evaluated rather than repeatedly manipulated at home.

A hernia that was previously soft or reducible but becomes firm, very painful, increasingly swollen, or no longer moves back into place can indicate incarceration or another complication.

If those changes occur along with severe pain, vomiting, or changes in skin color, seek emergency medical care.

How Is a Strangulated Hernia Diagnosed?

Evaluation begins with the patient's symptoms and a physical examination.

A healthcare professional may evaluate:

• Location of the hernia
• Severity and onset of pain
• Tenderness or swelling
• Whether the hernia appears trapped
• Skin changes around the bulge
• Nausea, vomiting, or other digestive symptoms
• Signs that the bowel may be involved

Imaging may be used when additional information is needed about the hernia and the tissue involved. Depending on the clinical situation, this may include ultrasound or CT imaging.

Because suspected strangulation is time-sensitive, diagnostic testing should not unnecessarily delay treatment when the clinical findings indicate an emergency.

How Is a Strangulated Hernia Treated?

A strangulated hernia generally requires emergency surgery to address the trapped tissue and repair the hernia. MedlinePlus identifies strangulation with compromised intestinal blood supply as a situation requiring emergency surgery.

During treatment, the surgical team evaluates the trapped tissue and restores it to its appropriate position when possible. The hernia defect is then repaired.

The exact operation depends on:

• Type and location of the hernia
• Tissue contained within the hernia
• Condition of the trapped tissue
• Presence of bowel obstruction
• Previous abdominal surgery
• Overall health of the patient

Treatment for an emergency strangulated hernia may therefore be different from a planned hernia repair.

When Should You Go to the Emergency Room for a Hernia?

Seek emergency medical care for a known or suspected hernia accompanied by sudden, severe, or rapidly worsening symptoms.

Warning signs include:

• Severe or rapidly worsening pain
• A suddenly painful or tender hernia
• A bulge that becomes firm or no longer moves back into place
• Persistent nausea or vomiting
• Significant abdominal swelling
• Redness, paleness, or darkening of skin around the hernia
• Severe abdominal symptoms with inability to pass stool or gas

A strangulated hernia cannot be reliably diagnosed based on symptoms alone. These warning signs require medical evaluation to determine whether incarceration, strangulation, bowel obstruction, or another condition is present.

Can a Strangulated Hernia Be Prevented?

There is no guaranteed way to prevent every strangulated hernia.

The most important step is to have a known or suspected hernia appropriately evaluated, particularly if it becomes painful, enlarges, becomes harder to reduce, or changes over time.

Whether a hernia should be monitored or surgically repaired depends on factors such as:

• Hernia type
• Size and location
• Symptoms
• Whether the hernia is reducible
• Individual risk of complications
• Overall health
• Previous hernia repairs

Some hernia types have a greater risk of complications and are more likely to be recommended for repair.

Should You Wait for a Hernia to Become Painful Before Seeing a Surgeon?

Not necessarily.

Many hernias are not emergencies when first diagnosed, and some can be safely monitored. However, treatment recommendations differ considerably by hernia type.

For example, some minimally symptomatic inguinal hernias may be monitored, while femoral and Spigelian hernias generally warrant surgical evaluation because of their greater risk of becoming trapped.

An elective hernia evaluation allows a surgeon to identify the type of hernia and discuss whether monitoring or planned repair is appropriate before an emergency occurs.

Hernia Evaluation and Surgery in the East Bay

Hernia Innovations provides evaluation and surgical treatment for inguinal, femoral, umbilical, incisional, epigastric, Spigelian, and other abdominal wall hernias throughout the East Bay.

Our board-certified surgeons evaluate the type and location of the hernia, symptoms, medical history, and individual risk factors to determine whether monitoring or planned surgical repair may be appropriate.

Hernia Innovations is not a substitute for emergency medical care. If you are experiencing symptoms of a possible strangulated hernia, seek emergency medical attention rather than waiting for a routine office appointment.

For non-emergency hernia evaluation, call (925) 940-1025 or request an appointment online.

Frequently Asked Questions About Strangulated Hernias

What is the first sign of a strangulated hernia?

There is no single symptom that occurs first in every patient. Sudden or rapidly worsening pain at the hernia site is an important warning sign, particularly when accompanied by tenderness, swelling, vomiting, or changes in the appearance of the hernia.

How do you know if a hernia is strangulated?

A strangulated hernia cannot be confirmed based on symptoms alone. Warning signs can include severe or worsening pain, significant tenderness, nausea or vomiting, and changes in skin color around the hernia. Emergency medical evaluation is necessary when strangulation is suspected.

Is a strangulated hernia an emergency?

Yes. A strangulated hernia is a medical emergency because blood flow to trapped tissue has been compromised. Emergency treatment is necessary to prevent serious tissue damage and other complications.

What is the difference between an incarcerated and strangulated hernia?

An incarcerated hernia contains tissue that has become trapped and cannot return to its normal position. A strangulated hernia occurs when the trapped tissue also loses adequate blood supply.

Can a strangulated hernia go away on its own?

No. A suspected strangulated hernia requires emergency medical treatment. Waiting for symptoms to resolve can allow the affected tissue to become seriously damaged.

Does a strangulated hernia always cause severe pain?

Severe or rapidly worsening pain is an important warning sign, but symptoms can vary depending on the hernia and the tissue involved. A sudden change in a known hernia, particularly with tenderness, vomiting, swelling, or skin changes, should be evaluated promptly.

What happens if a strangulated hernia is not treated?

Without adequate blood flow, trapped tissue can become damaged. Untreated strangulation can lead to serious complications, including tissue death and severe infection.

Does a strangulated hernia require surgery?

Strangulated hernias generally require emergency surgical treatment to address the trapped tissue and repair the hernia.